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	<title>复工申请平台</title>
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</head>
<head th:include="include :: header"></head>
<body class="">

<div class="container m-t">
	<br>
	<br>
	<h1 class="strong text-center">企业复工申请</h1>
	<br>
	<div class="col-xs-12">
		<hr style="width: 80%;">
	</div>
	<br>
	<br>
	<br>
	<div class="col-xs-12">
		<form id="signupForm" class="form-horizontal">
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">企业名称</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="name" name="name" placeholder="企业名称">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">机构代码</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="code" name="code" placeholder="组织机构代码">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">详细地址</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="address" name="address" placeholder="详细地址">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">联系人</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="connect" name="connect" placeholder="联系人">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">联系电话</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="phone" name="phone" placeholder="联系电话">
				</div>
			</div>
			<br>
			<div class="form-group">
				<label for="inputEmail3" class="col-sm-2 control-label">申请返回时间</label>
				<div class="col-sm-7 col-sm-offset-1">
					<input type="text" class="form-control" id="workTime" name="workTime" placeholder="申请返回时间">
				</div>
			</div>
			<br>
			<div class="form-group m-t-lg">
				<div class="col-sm-offset-3 col-sm-7">
					<button class="btn btn-default" id="btnSubmit">提交申请</button>
				</div>
			</div>
			<br>
			<br>
			<br>
			<br>
		</form>
	</div>


</div>
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<div th:include="include :: footer"></div>
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